The theory of knowledge and the third psychoanalytic revolution

Much of Freud's theoretical work rests on his metapsychological assumption that split the mind from the brain. In recent decades, this assumption has increasingly constrained the progress of psychodynamic science. During those same decades rapid progress in the traditional sciences, particularly neuroscience, evolution, and brain imaging, has set the stage for major advances in our understanding of the mind, and the brain. Leaders in both traditional and psychodynamic science have identified the reintegration of the mind-brain split, and its related problems of consciousness and knowledge, as a focus of 21st century discovery. Following Freud's revolutionary discovery of the unconscious and psychoanalysis, the period after World War II saw a second, post-Freudian psychoanalytic revolution. Psychopharmacology and the therapeutic use of empathy became widespread. Much of classical theory became increasingly obsolescent. We are thus entering the early stages of a third psychoanalytic revolution seeking a reintegration of mind and body that was not possible in Freud's time. The implications for theory, vocabulary, and technique present exciting and daunting challenges. Bowlby, who early rejected metapsychology, was a brilliant leader in these efforts. More recently, neuroanatomy and MRI studies of separation and empathy, reviewed here, have supported many of the most important clinical hypotheses of modern psychoanalysis. This progress illuminates a royal road to reuniting traditional and psychoanalytic science through solution of the problem of knowledge.     

Contraceptive use and associations with intimate partner violence among a population-based sample of New Zealand women

AIM: To outline the use of contraception among a representative sample of New Zealand women, and explore associations with intimate partner violence (IPV), and contraception and condom use. METHODS: Face-to-face interviews were conducted with a random sample of 2790 women who had ever had sexual intercourse, aged 18-64 years old in two regions (urban and rural) in New Zealand. Analyses were conducted using logistic regression and Wald chi(2) tests. RESULTS: Almost all women had used contraception at some point in their life, and almost one half of all women 18-49 years were currently using methods of contraception. Contraceptive use and methods varied significantly by location. Women who had ever experienced IPV were significantly more likely to report having ever used contraception, compared with women who had not experienced IPV (91% vs 85.2%). While having a partner who refused to use or tried to stop women from using a method of contraception was rare, it was significantly more common among women who had ever experienced IPV (5.4% vs 1.3%). CONCLUSIONS: Most women have used contraception at some point. Women who have ever experienced IPV were: more likely to have used contraception than women who have not experienced IPV, and to have had partners who refused to use condoms or prevented women from using contraception. Partner refusal may be a key indicator of IPV. These findings emphasise the importance of family violence screening at routine health consultations.     

Ask and you will learn

Talking to his patients led nurse specialist Stephen Whitehead to improve the service he provides for men following radical prostatectomy.     

A randomised control trial of oral health education provided by a health visitor to parents of pre-school children

OBJECTIVES: To determine the effect of oral health education carried out by a specially trained health visitor on the dental health of young children. DESIGN AND SETTING: Children, who were recruited during their 8-month distraction-hearing test, were randomly allocated to intervention and control groups. A home visit by the health visitor was arranged to parents in the intervention group who were given dental health advice. A second home visit, when the child was about 20 months old, focused on a completed diet record sheet and discussions about what and when the child was eating and drinking. Children in the intervention group received a toothbrush and toothpaste containing 440 ppm fluoride at both visits while those in the control group received the level of care usually provided by health visitors in the area. The children's teeth were examined when they were three years old and two years later as part of a census survey of 5-year-old children in the area. MAIN OUTCOME MEASURES: The numbers of decayed, missing and filled tooth surfaces. RESULTS: 251 children were recruited to the control group and 250 to the intervention group. At age three, they were examined; the mean dmfs scores were 2.19 (95% Confidence Interval: 1.41-2.97) in the control group (n = 171) and 2.03 (CI: 1.39-2.67) in the intervention group (n = 181). During the census survey 276 of the children in the study were examined at school. At this age the mean dmfs scores were 4.84 (CI: 3.39-6.29) in the control group (n = 129) and 3.99 (CI: 2.54-5.04) in the intervention group (n = 147). However, the mean dmfs of the remaining 2,253 children who were examined was 5.94 (CI: 5.55-6.33). CONCLUSIONS: No statistically significant differences in mean dmfs scores were found between the control and intervention groups of children, although, as the children grew older, the gap between them widened. However, the mean dmfs score of other 5-year-olds in the area was significantly worse than that of children in the intervention group. Asking the control parents to take part in the study and examining their children at three years may have had an effect on their dental health status and have made it more difficult to detect any differences achieved by the programme.     

The use of CAM in a New Zealand-based general practice: a multiple case-study

OBJECTIVE: To explore the factors which underpin the healthcare consumers' decision-making to use CAM in the primary setting. DESIGN: An explorative, multiple case-study of seven convenience-sampled participants where in-depth, semi-structured interviews were employed. RESULTS: The findings showed that participants would continue to utilise CAM, even where CAM had no scientific evidence. The participants believed that CAM should be integrated into mainstream healthcare service delivery. CONCLUSIONS: There are few international studies that have reported on the utilisation and prevalence of CAM within the General Practice (GP) or clinic setting. The reasons why clients select specific CAM therapies, where they are offered in these settings, remain unclear. This study, however, casts further light on this matter.     

Mutations in 2 distinct genetic pathways result in cerebral cavernous malformations in mice

Cerebral cavernous malformations (CCMs) are a common type of vascular malformation in the brain that are a major cause of hemorrhagic stroke. This condition has been independently linked to 3 separate genes: Krev1 interaction trapped (KRIT1), Cerebral cavernous malformation 2 (CCM2), and Programmed cell death 10 (PDCD10). Despite the commonality in disease pathology caused by mutations in these 3 genes, we found that the loss of Pdcd10 results in significantly different developmental, cell biological, and signaling phenotypes from those seen in the absence of Ccm2 and Krit1. PDCD10 bound to germinal center kinase III (GCKIII) family members, a subset of serine-threonine kinases, and facilitated lumen formation by endothelial cells both in vivo and in vitro. These findings suggest that CCM may be a common tissue manifestation of distinct mechanistic pathways. Nevertheless, loss of heterozygosity (LOH) for either Pdcd10 or Ccm2 resulted in CCMs in mice. The murine phenotype induced by loss of either protein reproduced all of the key clinical features observed in human patients with CCM, as determined by direct comparison with genotype-specific human surgical specimens. These results suggest that CCM may be more effectively treated by directing therapies based on the underlying genetic mutation rather than treating the condition as a single clinical entity.     

A pilot study to assess the use of the gonadotrophin antagonist cetrorelix in preserving ovarian function during chemotherapy

Cyclophosphamide treatment can cause premature ovarian failure. This pilot study evaluates the protective effect of the gonadotrophin releasing hormone (GnRH) antagonist, cetrorelix, on ovarian function, when used during cyclophosphamide chemotherapy in women aged 18-35. Primary outcomes measured were serum follicle stimulating hormone (FSH) and inhibin prior to and at 6 and 12 months after chemotherapy. Secondary outcomes were hormonal evidence of a suppressive effect and the side effect profile.